DDAM Core Syllabus
DDAM Core Competencies
The Faculty of Occupational Medicine of the Royal College of Physicians of London was established “to develop and maintain the good practice of occupational medicine with a view to providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity”.
The Diploma in Disability Assessment Medicine is a professional qualification for doctors in the assessment of disability.
It is recognised that sympathetic and competent assessment of individuals with disability will remain an essential skill of virtually all practising physicians and is critically important for doctors undertaking work in relation to the award of state sickness and disability benefits. The government is encouraging a shift in emphasis from ‘disability’ to ‘ability’ and competent clinical assessment is one of the first parts of this process. Professional examination success in this discipline will become increasingly important for those doctors whose main practice is disability assessment.
D1. Candidates are required to have EITHER
(a) attended an approved training course
(b) held a supervised post which entails significant experience of the assessment and/or management of disability. This should equate to a time of at least 6 months full time or equivalent part time employment within the last 10 years but with at least some of that required training or experience within the last three years. Candidates who are otherwise eligible to take the examination are nevertheless advised to attend all or selected parts of an approved course.
Applications for admission to the examination must be made on the Faculty’s generic application form, which is available from the forms page, by the published closing date and accompanied by the appropriate fee[s]. The Faculty must receive the original signed form and under no circumstances will a photocopied form or faxed form be accepted.
FORMAT OF THE EXAMINATION
D2. The examination is in 4 parts. Candidates are required to pass:
1) a multiple choice question (MCQ) paper,
2) 2 modified essay question (MEQ) papers
3) a clinical examination.
D3. The MCQ and both MEQ papers will be administered on the same day. Candidates will be required to pass all 3 papers before progressing to the clinical section of the examination, which will usually be 5 to 6 weeks later.
D4. Candidates failing the written examinations will be permitted to resit the examination no more than 5 further times. Candidates failing the clinical section of the examination will be permitted 5 further attempts at the clinical section.
THE MCQ PAPER
D5. The MCQ paper is designed to test a candidate’s knowledge. The MCQ examination will be primarily in the “single best answer” format. Each question will take the form of a stem and 5 options. Only one option will be considered the correct answer for each question stem. Other options may be partially correct but candidates should select the most appropriate answer. The paper lasts for 1 hour and the number of questions will be up to 60.
D6. Answers should be recorded on the machine-readable sheet provided by blanking out the space corresponding to the answer chosen. One mark will be awarded for each correct answer. No mark will be given for any incorrect answer or no answer. A zero mark will be given for any answer where 2 answers are given, even if one of them is the correct answer. An answer sheet may contain spaces for more answers than required by the examination.
D7. A number of questions may be included for trial purposes but will not be used when calculating scores. These questions will not be distinguishable from other questions and may occur anywhere on the paper.
D8. The Faculty of Occupational Medicine is no longer able to give out any past examination papers.
D9. The MCQ is machine marked and the results are statistically analysed to ensure standardisation with previous DDAM MCQ examinations and to exclude unsatisfactory questions. The pass mark may therefore vary between sittings of the examination.
THE MEQ PAPERS
D10. The MEQ papers are designed to test the candidate’s problem-solving skills in the field of disability assessment medicine. The first MEQ paper comprises 3 questions and lasts for 1 hour, the second MEQ paper comprises 4 questions and lasts for 2 hours. All questions are compulsory and each must be answered in a separate answer booklet. Questions may carry different proportions of the overall mark for the paper. Candidates will be given guidance about any weighting of individual questions.
D11. There is a set of key areas of knowledge (constructs) which the candidate will be expected to demonstrate. In the first paper, the questions will be related to the interpretation of medical data for a lay person. The second paper will cover: relevant clinical factors; relevant occupational and/or psychosocial factors; critical evaluation of data; ability to draw appropriate conclusions about functional capacity/work related factors/life or health insurance factors; and ability to make appropriate recommendations. Not all constructs will necessarily be applicable to each question. A detailed knowledge of Government allowances and forms is not required.
D12. Answers may be given in note form or any other suitable style or format, such as diagrams or algorithms. Abbreviations should be avoided although medical terminology may be used unless the question requires interpretation of medical data for a non-medical person. Answers must be legible. Marks will be lost if the examiner is unable to read the answer.
D13. Each question is marked by a single, Faculty trained, examiner. As well as scores for each construct appropriately addressed, the examiner will identify the answer as “Pass”, “Borderline Pass”, Borderline Fail” or “Fail”. All the borderline fail and fail answers and a proportion of the others are then independently marked by a separate examiner. If differing results cannot be rationalised, the Chief Examiner will re-mark the question and arbitrate. Candidates will normally be allowed to fail one of the questions while still passing the papers. The overall pass mark will vary slightly from paper to paper as a result of standardisation of each diet of examinations. The Chief Examiner responsible for the DDAM examination will write to any candidates who are unsuccessful in the MEQ to give detailed feedback on their performance.
D14. The clinical examination will be conducted using the objective, structured clinical examination (OSCE) format. Equipment will be provided but candidates should bring their own stethoscopes. Candidates will see 2 medium and 4 short cases. One of the medium cases will be a psychiatric patient, portrayed by a role player. The medium cases will each last 30 minutes and the short cases up to 15 minutes.
D15. The candidate’s technique in history taking and physical examination will be observed in each case by one examiner who will remain with that patient throughout. Candidates will therefore see up to 6 separate examiners (some examiners will examine more than one station) in one sitting of the clinical examination.
D16. As well as scores for each element of the history, examination and the correct answering of questions, the examiner will identify the performance as “Pass”, “Borderline Pass”, “Borderline Fail” or “Fail”. All examiners for the clinical examination, and the Chief Examiner, will discuss “Fail” or “Borderline Fail” cases for each candidate before agreeing the overall grade to be awarded. Candidates will normally be allowed to fail one of the short cases while still passing the examination. The overall pass mark may vary slightly from examination to examination as a result of standardisation of each diet of examinations.
D17. The Chief Examiner responsible for the DDAM examination will write to any unsuccessful candidates to give detailed feedback on their performance.
DDAM Core Syllabus
Legal aspects (10%)
- Disability discrimination legislation
- Other current relevant legislation including
- health and safety
- Eligibility for Benefit (Department of Work & Pensions (DWP))
- General comparison of UK and other EU national systems
Terms and concepts (5%)
- Definition of terms
- incapacity, invalidity, disability
- impairment, disability, handicap WHO – ICIDH (all versions)
- functional ability
- Definition of different models of disability
- medical model
- social model
- bio-psychosocial model
- Indices of independence and mobility: general knowledge of their strengths/weaknesses and their usefulness as
- status/outcome measures
- activities of daily living
- functional limitation profiles
- sickness impact profiles
- other indices
Disability Assessment – Principles and practice (20%)
- Standardised Disability Analysis
- principles of disability medical analysis
- Mental health and psychological evaluation
- Assessment of cognitive impairment
- Functional limitations and functional capacity assessment
- Standardised measurement
- psychometric testing: principles, applications and indications
- data collection and use in functional assessment: indices and scales
- functional capacity assessment: ability to perform job related functions safely
Clinical aspects of disability assessment (25%)
- Clinical knowledge, expertise, and examination of the patient
- Musculo-skeletal problems
- Cardio-respiratory diseases
- Neurological diseases and injuries
- including head injury and its possible sequelae
- Sensory disabilities
- Mental health problems
- Assessment of subjective and variable conditions including
- chronic fatigue syndrome
- post traumatic stress disorder
- Multiple impairments and their implications
- Other common conditions
- The care needs of the elderly
- The care needs of disabled children
- The needs of disabled school leavers
Work and the work environment (10%)
- Matching people and jobs
- Work analysis and adaptation
- Work environment analysis and adaptation
- Reasonable adjustment
- Definitions of rehabilitation and their relevance today
- Process of rehabilitation
- Types of disabling conditions, their implications for rehabilitation
- single event
- relapsing and progressive conditions
- Evaluating the outcome of rehabilitation
- importance of agreed outcome measures
- uses of different outcome measures
- Personal and social aspects
- Assessment of social and communication skills
- Assessment for return to work
- including analysis of job content and related factors
- health and safety aspects
- Possible outcomes and alternatives to previous employment
- The role of other agencies and medical specialists
- Assessment and guidance for non-work activities
- Rehabilitation aids and equipment
Assurance Medicine (5%)
- Medical risks
- principles and practice of life and disability underwriting types of policy
- group life and pension schemes including permanent total disability
- disability (Health) Insurance Terminal illness
- Confidentiality and ethics
- Consent to disclose medical information
- GMC guidelines
- Basic statistics and epidemiology
- Evidence based medicine
- Presentation and report writing skills
- Explanation of specialist terms to lay persons
DDAM Core Competencies
The following competencies and skills will be required by candidates:
- Have sufficient knowledge and clinical skills to:
- Obtain brief, as well as comprehensive, patient histories, with an emphasis on occupation, disability and lifestyle.
- Perform complete or focused physical examinations, as required
- Select appropriate diagnostic studies.
- Identify the impact of the complaint on activities of daily living.
- Provide high quality medical diagnosis and advice on treatment, rehabilitation, eligibility for benefit and applicability of the Disability Discrimination Act.
- (a) Take and record a general medical history from an individual, including reproductive, social family and behavioural characteristics;
- (b) take and record a complete chronological work history from any person capable of giving such a history;
- (c) for any job description given by a person who has worked in that job, make appropriate enquires of the informant in order to clarify the exact nature of the job or process, the materials used in that job and the condition under which the job was usually performed, to the extent of the knowledge of the informant.
- (d) Carry out a mental health assessment.
- (e) Carry out an assessment of mobility.
- (f) Administer the Personal Capability Assessment.
In addition to the above, the candidate will be able to undertake the following for each of the listed organ systems and/or disease grouping which follow:
- (a) recognise and describe the clinical features of occupational and environmental disorders, and their aetiological factors;
- (b) recognise and describe relevant investigations, their purpose and range of normal findings;
- (c) describe toxicological mechanisms, where relevant, including important interactions with other lifestyle factors, such as medications, tobacco smoking and alcohol consumption;
- (d) describe the impairment, disability and handicap arising from these medical disorders, in particular their effect on a person’s ability to work and on access to daily living and leisure activities.
- (e) undertake appropriate investigations, management and referral using an evidence based approach.
- (f) explain general eligibility for state benefits.
IN ADDITION TO THE GENERAL CLINICAL COMPETENCIES AND SKILLS ABOVE, CANDIDATES SHOULD HAVE DEVELOPED THE FOLLOWING COMPETENCIES AND SKILLS
CLINICAL EAR, NOSE AND THROAT
- Identify, diagnose and advise on patients with common ear, nose and throat conditions.
- Carry out a competent examination of the ENT system including the detection and assessment of disorders of the auditory canal; the tympanic membrane and the nasopharynx; including noise induced hearing loss; barotrauma
- Carry out otological examination.
- Interpret an audiogram.
- Identify and assess occupational eye injuries and disease and refer where appropriate. Identify the visual requirements for various occupations including regulatory requirements and correlate with job tasks and job hazards in determining fitness for duty.
- Perform ophthalmoscopy, testing for visual fields, colour vision and visual acuity.
- Assess patients with a cardiovascular disease and their fitness to work, and for rehabilitation or redeployment needs.
- Assess patients for peripheral vascular and cerebrovascular disease.
- Carry out a competent examination of the cardiovascular system including auscultation, determination of position of the apex beat, demonstration of signs of heart failure, assessment of heart rate and rhythmicity, measurement of blood pressure. Diagnose common abnormalities on ECG.
- Identify and assess occupational asthma and bronchoreactivity.
- Chronic obstructive pulmonary disease.
- Carry out a competent examination of the respiratory system including observation, palpation, percussion and auscultation.
- Perform diagnostic tests, including spirometry and interpret results of diagnostic investigations.
- Recognise diseases and disorders of the musculoskeletal system.
- Carry out a competent examination of the musculo-skeletal system including joint mobility, stability and function and muscle tone.
- Assess gait, exercise tolerance and overall mobility.
- Assess need for walking and mobility aids.
- Perform neurological and mental state examinations and assess occupational and environmental neurological disease or injury and fitness for work with particular reference to stroke, epilepsy, head injury and the degenerative neurological disorders.
- Carry out a competent examination of the neurological system including the cranial and peripheral nerves, the special senses, proprioception, reflexes and the higher intellectual functions.
- Take a complete psychiatric and psychosocial history, to include alcohol and drug abuse, and perform a mental state examination.
- Identify the impact of psychological conditions on fitness for work. Assess the impact of psychotropic medication for a specific job.
- Undertake clinical differential diagnosis of skin diseases and occupational causes by history, examination and diagnostic evaluation.
- Carry out a competent examination of the skin and be able to interpret patch tests.
DISABILITY MANAGEMENT & WORK FITNESS
- Assess disability and fitness for work. Advise on rehabilitation and redeployment.
- Determine the degree of impairment and disability which may be present in an injured or ill employee and determine capacity for work.